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NOTE TO PHYSICIAN Your patient is applying to the U.S. Department of Veterans Affairs (VA) for disability benefits. VA will consider the information you.
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How to fill out va form 21-0960a-4

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How to fill out VA Form 21-0960A-4:

01
Start by familiarizing yourself with the purpose of VA Form 21-0960A-4. This form is used to evaluate the degree of disability for mental disorders related to military service.
02
Ensure you have all the necessary information and documents before starting the form. You will need your personal details, military service information, and medical records related to your mental health.
03
Begin by filling out the personal information section, including your full name, social security number, contact information, and any other required details.
04
Move on to the military service information section. Input information such as your branch of service, dates of service, and any combat-related experiences you may have had.
05
Proceed to the medical history section. Provide a detailed account of your mental health conditions, including the nature of your illness, when it first started, and any treatments or medications you have received.
06
If applicable, complete the section on other disabilities. Include any additional illnesses or disabilities you may have that are not related to your mental health.
07
Next, answer the questions regarding your daily activities. Be honest and provide specific examples of how your mental health conditions impact your ability to perform routine tasks.
08
If you have received treatment from VA medical facilities or other providers, provide the necessary details in the treatment section.
09
Finally, review the completed form for accuracy and completeness. Make any necessary corrections before signing and submitting it to the appropriate VA office.

Who needs VA Form 21-0960A-4?

01
Veterans seeking disability benefits for mental health conditions related to their military service may need to fill out VA Form 21-0960A-4.
02
These individuals may be experiencing mental disorders such as post-traumatic stress disorder (PTSD), depression, anxiety, or any other condition caused or aggravated by their military service.
03
The form is instrumental in evaluating the severity of these mental health conditions and determining the appropriate level of disability compensation for eligible veterans.
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VA Form 21-0960A-4 is the Disability Benefits Questionnaire for the Examination of a PTSD Claim.
Veterans who are claiming disability benefits for PTSD are required to file VA Form 21-0960A-4.
VA Form 21-0960A-4 must be filled out by a qualified healthcare provider during a PTSD examination for a veteran's disability benefits claim.
The purpose of VA Form 21-0960A-4 is to gather information about a veteran's PTSD symptoms and their impact on daily functioning in order to help determine eligibility for disability benefits.
Information about a veteran's current PTSD symptoms, medical history, and functional limitations must be reported on VA Form 21-0960A-4.
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Relevant keywords

21-0960A-4 2011 1975 SSN OMB ICD JAN 90mm 0960A vba PRAMain 160mm reginfo disabilityexams VA21 XXXX epidemiological III Respondent diastolic entitlement pertain Vocational diagnoses predominantly CERTIFICATION RATIONALE gov herein SUBMITTING INCURRED HYPERTENSION RE

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